Modulation of inflammation by vitamin E and C supplementation prior to anterior cruciate ligament surgery

Free Radic Biol Med. 2009 Mar 1;46(5):599-606. doi: 10.1016/j.freeradbiomed.2008.11.006. Epub 2008 Nov 27.


Muscle atrophy commonly follows anterior cruciate ligament (ACL) injury and surgery. Proinflammatory cytokines can induce and exacerbate oxidative stress, potentiating muscle atrophy. The purpose of this study was to evaluate the influence of prior antioxidant (AO) supplementation on circulating cytokines following ACL surgery. A randomized, double-blind, placebo-controlled trial was conducted in men undergoing ACL surgery, who were randomly assigned to either: (1) AO (200 IU of vitamin E (50% d-alpha-tocopheryl acetate and 50% d-alpha-tocopherol) and 500 mg ascorbic acid), or (2) matching placebos (PL). Subjects took supplements twice daily for 2 weeks prior to and up to 12 weeks after surgery. Each subject provided five blood samples: (1) baseline (Bsl, prior to supplementation and approximately 2 weeks prior to surgery), (2) presurgery (Pre), (3) 90 min, (4) 72 h, and (5) 7 days postsurgery. Following surgery, inflammation and muscle damage increased in both groups, as assessed by increased circulating IL-6, C-reactive protein, and creatine kinase. During AO supplementation, plasma alpha-T and AA increased while gamma-T concentrations decreased significantly (P< 0.05). At 90 min the AO group displayed a significant decrease in AA, an inverse correlation between AA and (interleukin) IL-8 (r(2)= 0.50, P< 0.05), and a significantly lower IL-10 response than that of the PL group. IL-10 was significantly elevated at 90 min and 72 h in the PL group. In summary, our findings show that circulating inflammatory cytokines increase and AO supplementation attenuated the increase in IL-10 in patients post-ACL surgery.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / immunology*
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries
  • Ascorbic Acid / administration & dosage*
  • C-Reactive Protein / genetics
  • C-Reactive Protein / metabolism
  • Creatine Kinase / blood
  • Cytokines / blood
  • Dietary Supplements*
  • Double-Blind Method
  • Humans
  • Inflammation
  • Male
  • Muscular Atrophy, Spinal / blood
  • Muscular Atrophy, Spinal / etiology
  • Muscular Atrophy, Spinal / prevention & control*
  • Reconstructive Surgical Procedures / adverse effects
  • alpha-Tocopherol / administration & dosage*
  • alpha-Tocopherol / analogs & derivatives
  • alpha-Tocopherol / metabolism
  • gamma-Tocopherol / metabolism


  • Cytokines
  • gamma-Tocopherol
  • C-Reactive Protein
  • Creatine Kinase
  • alpha-Tocopherol
  • Ascorbic Acid